Microvascular replantation of a completely avulsed scalp

Abstract

Total scalp avulsion is an unusual injury. To obtain good functional and cosmetic results, immediate revascularization using microsurgical techniques and replacement of the scalp in the correct anatomical position is the procedure of choice. This article describes a case report of successful replantation of a totally avulsed scalp from a 26-year-old male. Bilateral superficial temporal vessel anastomoses were performed using reversed autologous long saphenous vein grafts on the right side and direct repair on the left. Points of technique are discussed and the literature is reviewed.

Total scalp avulsion with microvascular reanastomosis: A case report and literature review

“…One very common location for postoperative necrosis to occur is in the area of the occiput, as in our case (3,9,(11)(12)(13)(14). Although we believe that our case was more likely related to the crush injury sustained by the flap in that specific area, the majority of reported cases of occipital failure seem to be due to postoperative venous congestion (11,13,14).…”

“…Because there is often severe trauma to the vessels within the zone of injury (requiring a significant amount of length to be cut back), many authors have recommended the use of interposed vein grafts when replanting the scalp to provide adequate length for a tension-free anastomosis (9,10,18,19). While this certainly increases the length of the vessels, making for an easier anastomosis, it also has the drawbacks of doubling the number of anastomoses that can leak, clot or fail during the postoperative period; creating surgical complications in the area of harvest; and increasing ischemia time due to the time required for harvest, preparation and the extra anastomoses.…”

“…Since this procedure, many avulsed scalps, both partial and complete, have been replanted successfully using a widely variable number of arteries and veins -the vast majority using two or more arteries and as many veins as possible (8)(9)(10). One consistent finding in these replanted scalps has been postoperative congestion in the occipital region (3,8,9,(11)(12)(13)(14); various methods have been attempted to control this including decreasing the number of arteries reanastomosed to increase the vein-to-artery ratio (11) as well as the use of leeches postoperatively (15). Although most articles still seem to highlight their authors' attempts at reanastomosing as many vessels as possible, many articles have demonstrated that a scalp (even including up to two-thirds of the face [16]) can be successfully replanted using as few as one artery and one vein (11,16).…”

A succesful replantation of total scalp, forehead, left ear, eyebrows and upper eyelids amputation and 6-year follow-up results

“…Daha sonra literatürde başarılı sonuçlardan oluşan olgu sunumları yayınlandı. [4][5][6][7][8] En geniş seri 20 olgu içermekteydi ve 1996 yılında Cheng tarafından yayınlanmıştı. [11] Skalp replantasyonunun saçların tekrar gelişimi açısından, skalp innervasyonunun geri kazanılması açısından, özellikle bizim olgumuzda olduğu gibi alın derisi, göz kapakları ve kulak gibi benzersiz yapıları yeniden kazandırabilmesi açısından kozmetik ve psikolojik yararları düşünüldüğünde diğer yöntem-lere üstünlüğü tartışılmazdır.…”

“…[1,2] 1976 yılında Miller ve arkadaşları [3] mikrocerrahi teknikle ilk kez avülze skalp replantasyonunu uygulamış ve mükemmel sonuç almışlardır. Bu çalışmadan sonra Buncke ve arkadaşları [4] Van Beek ve Zook [5] ve diğer başka yazarlar [6][7][8] kendi başarılı deneyimlerini sunmuşlardır ve skalp avülsiyonlarında mikrocerrahi ile replantasyon günümüzde kullanılan seçkin tedavi yöntemi halini almıştır. [9][10][11][12][13][14][15][16][17] Ancak, ekstremite amputasyonlarındakinin tersine kulak, burun, skalp gibi dokuların replantasyonu vasküler yapılarının boyutlarının küçüklüğü ve de bunların yaralanmalarının natürüne bağlı zedelenmeleri nedeniyle, birçok mikrocerrahi kliniğinde elde edilen tecrübelere rağmen, günümüzde halen zorluk arzeder.…”